State hospitals lack oversight, accountability

Published
6:24 pm CDT, Wednesday, June 12, 2013

Already feeling federal pressure to improve conditions in its living centers for those with intellectual disabilities, Texas officials now are scrambling to respond to conditions at a state hospital that cost a woman her life.

Rather than focus on just getting by again, Texas officials should focus on changes that maximize the quality of care in institutions for the mentally ill and intellectually disabled. The first big step will be a top-to-bottom review of the existing administration and delivery of care that is seriously flawed.

As the American-Statesman reported earlier this month, Ann Simmons died in the Terrell State Hospital in February 2012. A federal inquiry into the death — prompted by an American-Statesman report — revealed that Simmons had been improperly restrained for 31 hours. The investigation identified the cause of her death as pulmonary thromboembolism. The Centers for Medicare and Medicaid report said Simmons was held in restraints for too long and failed to receive proper nursing care.

Simmons was 62 when she died. The retired elementary school teacher was a resident of the East Texas town of Pittsburg. Her husband told Ball she made friends easily and was active in the community. Simmons was diagnosed with bipolar disorder. In early, 2012 Ann Simmons realized that her disorder was becoming uncontrollable and asked her husband, Bob, to take her to the hospital. She arrived at the Terrell State Hospital on Feb. 15. Three days later, she was dead.

The state hospital staff restrained Simmons because she pulled out a nasal gastric tube being used to feed her. The Medicare agency’s report noted other patients were unnecessarily restrained. Several of those restraints involved nasal gastric tubes, which provide liquids and nutrition to patients who refuse to eat or drink. The tubes are inserted through the nose, down the throat and into the stomach.

Ball reported that when an investigator asked an employee if restraints were used as a convenience for the staff, the response was, “Well, yeah, I guess you could say that.”

State officials say the tubes will no longer be used at Terrell. That’s a step in the right direction, but not nearly enough. Much more corrective action is required.

Had it not been for the family’s persistence in trying to get answers about why Simmons died, she might have been just another Texas statistic that officials don’t talk about. Ball reported that between 2005 and 2012 there have been 170 deaths in the 10 mental hospitals operated around the state. Some of those deaths may have been natural, but the Simmons report raises concerns about system accountability in mental institutions.

A lack of oversight and accountability and official indifference — there is no other way to characterize it — wrings the humanity out of a system that allowed Simmons to die. No one at the Terrell State Hospital has been disciplined in Simmons’ death.

When a patient dies in a state hospital, there is no independent investigation into the cause. Prison deaths get more scrutiny than deaths in the state hospitals do.

Except in cases of legal executions, prison officials order autopsies performed on inmates who die in custody. In state hospitals, it is the hospital staff that investigates deaths. That raises serious questions about objectivity and rigor of those inquiries.

Is it any surprise that internal investigations regularly clear doctors of improper care even when those same reviews note problems involving diagnosis and treatment? Autopsies are not required in the state hospital deaths.

Obviously, there is a problem, and just as obviously, sustainable solutions are going to cost money.

The Legislature has never been overly generous in mental health funding, but ignoring mental illness doesn’t make it go away.

Treatment of the mentally ill is an uncomfortable topic of conversation for elected officials who would much rather talk about issues that make good sound bites. Sound bites are no substitute for sound policy that would fix an obvious accountability failing in the state hospital system.

The federal investigation into Simmons’ death has raised concerns, but it’s the same kinds of concerns that arise whenever the state is embarrassed. Somebody will express shock and dismay but pretty soon, attention shifts and very little changes.

The report on Simmons’ death follows closely on the heels of a federal threat to withhold funding from the state living centers for the third time in 14 months.

Those two are a loud and clear warning that conditions in both the state hospitals and the state living centers require attention.

No, that attention won’t come cheap. The cost of doing little or nothing is much higher in terms of lives and money.